Heart failure

jennifer12345's version from 2018-09-25 19:31

Section 1

Question Answer
Sympathetic nervous system response to HFincrease in sympathetic tone, increase in PVR, chronotropy, inotropy (increase force & rate contraction)
Renin angiotensin system response to HFincreased SVR, increased salt/water retention, excessive vasoconstriction, MI, cardiac arrhythmias

Section 2

Question Answer
ANPfound in atria, diuretic and vasodilatory effects
BNPfound in cardiac ventricles, diuretic and vasodilatory effects, counteract RAS system

Section 3

Question Answer
Systolic dysfunction HFrEFEF < 40%, low CO, increased ventricular end diastolic pressures and volumes (ineffective pump)
Diastolic dysfunction HFpEFcannot relax, EF normal, inadequate SV, elevated end diastolic pressures

Section 4

Question Answer
Left sided failurerales, tachypnea, S3, murmurs
Right sided failureJVD, peripheral edema, perioral or peripheral cyanosis, hepatomegaly, ascites

Section 5

Question Answer
Loop diureticsintroduced first if signs of volume overload
ACE inhibitors, or ARBSif no overt failure or already taking a diuretic
Beta blockersuse after the patient is stable on ACE inhibitors , can worsen exacerbations- start once stable
Hydralazine/nitratesuse with African Americans, or if persistent symptoms despite therapy
Aldosterone antagonist (spironolactone)improve survival with class 3/4 symptoms and reduced LV EF with normal plasma K
Digoxinreduce hospitalizations for HF, or pts with afib, for rate control. Only indicated in systolic HF
ARB or hydralazine/isosorbide dinitrateconsider in patients with ACE-I contraindications or intolerance
ACE inhibitorsprovide rapid hemodynamic benefit, reduce mortality, benefits take 1-2 months
Calcium channel blockers (verapamil)only use in diastolic dysfunction, good rate control

Section 6

Question Answer
Adverse effects of ACE inhibitorscough, hyperkalemia, renal insufficiency
Adverse effects of diureticselectrolyte abnormalities, renal insufficiency
Signs of worsening heart failure on beta blockersweight gain, increased SOB, DOE, PND, edema, increased fatigue
Signs of digoxin toxicityfatigue, anorexia, weakness, nausea, arrhythmias, diarrhea, visual disturbances